Week 4 reflections: trauma

At the end of each week, we’ll invite you to take a few moments to reflect on the texts, topics and ideas that we’ve been exploring together in the week’s course steps. We’d love to hear any further comments or insights that you have about the course materials we’ve been looking at over the last few days, and we’ll also be sharing a few of our own final thoughts as we round up the week.

You can read our reflections on Week 4 below.

The band of brothers

In the first half of the week, we looked at the origins of our modern-day, medical understanding of Post-Traumatic Stress Disorder (PTSD). Although the human experience of trauma has been explored by writers for over 2000 years, it was only in the military hospitals of the First World War that doctors began to diagnose and treat the symptoms that so often develop following a traumatic encounter. Together, we’ve looked at war poems, journal extracts and old video footage, to gain an insight into the debilitating psychological and physical effects of war trauma on the soldiers who experienced it.

Some of you may have been surprised by the very physical manifestations of trauma that we witnessed in the footage from First World War military hospitals; yet the profound interconnection of mind and body is a theme that continues to recur throughout this course. So far, we’ve learned that stress can cause physical pain, and that grief and shock can result in symptoms that mimic a heart attack, and those learners whose fathers, uncles or grandfathers fought in the war may well have witnessed the tremors, tics, speech difficulties and sleeping problems which so many returning soldiers experienced. One aspect of trauma that we’ve touched on very little in the week’s course materials is secondary trauma, whereby the behavioural changes sometimes caused by a traumatic experience result in extreme distress and difficulty for a trauma-sufferer’s loved ones. The potentially damaging impact of PTSD on close friends and family members often goes unacknowledged, and greater support needs to be provided for loved ones, to help them to understand and live with a person who is experiencing the condition.

We’re aware that we have been using ‘shell shock’ and ‘PTSD’ as semi-synonymous terms this week, so we thought we’d take this opportunity to say a bit more about the relationship and difference between the two. The point we were making is that the terrible psychological and psychosomatic damage of war was first formally diagnosed in the First World War, and that this was the starting-point on the road that led to the modern diagnosis of PTSD. Flashback or unwanted memory, which Jennifer Wild reminded us is the main characteristic of PTSD, is clearly present in the poetic representations of “shell shock” by Gibson and Owen (and in Virginia Woolf’s remarkable portrayal of the shell-shocked Septimus Smith in her novel Mrs Dalloway), but muscle rigidity and nervous tics were more visible manifestations of “shell shock.”

Medically vague – and yet, circumstantially, specific to the First World War – the term ‘shell shock’ is thought to have originated among the soldiers in the trenches, though its first recorded usage was by psychologist Charles Myers, in his 1915 article for The Lancet. As a diagnosis, shell shock was ill-defined, referring to a variety of psychological and physical symptoms experienced by soldiers as a result of their involvement in combat. It can encompass direct, physical reactions to the noise and chaos of battle (for instance, tinnitus and dizziness), and it need not manifest itself in the traumatic re-experiencing typical of PTSD. Whereas PTSD, as we learned this week, can result from any experience that is traumatic or life-threatening for the individual, shell shock refers to the symptoms triggered by the horrific events of that particular war. The terms are not interchangeable, and PTSD is not simply a modernised term for shell shock. Nevertheless, it is evident that the First World War marked a significant turning point in the medical understanding and treatment of conditions that were psychological rather than physical in origin. Confronted with such extreme symptoms, doctors began to appreciate trauma as a real and debilitating condition, and the work of psychologist W. H. R. Rivers, in particular, pre-empted modern psychoanalytical approaches to therapy.

For us, and perhaps for some of you as well, this photograph brings to mind Shakespeare’s well-known phrase, the ‘band of brothers’. This image of the wounded soldiers, united in adversity, reminds us of Henry V’s appeal – in Shakespeare’s play of the same name – to the indissoluble bond forged between men who fight together in battle:

This story shall the good man teach his son;
And Crispin Crispian shall ne’er go by,
From this day to the ending of the world,
But we in it shall be remember’d;
We few, we happy few, we band of brothers;
For he to-day that sheds his blood with me
Shall be my brother; be he ne’er so vile,
This day shall gentle his condition:

We may, of course, question the motivations behind this photograph: why was the picture taken, and did the men choose to be there? It’s possible this image of a ‘band of brothers’, who appear so serene and composed despite their life-changing physical injuries, might have been used for propaganda purposes, to boost morale and dignify the carnage of war. Henry V’s speech too, of course, is a kind of propaganda, which plays on a collective yearning for legacy and camaraderie to urge courage in battle against all the odds. But while the notion might sometimes have been exploited for the purposes of propaganda, there is no doubt that a ‘band of brothers’ did exist in the trenches (though it may not have transcended class boundaries in the way Henry V’s speech envisions). Following the war, stories emerged of soldiers on the frontline helping to hide their shell-shocked friends, in the hope that this might spare them, for a short time, from the horrors of battle. These soldiers, it seems, appreciated the importance of peace and rest in the recovery process, and understood that the debilitating symptoms exhibited by their fellows were evidence not of cowardice, but rather, of a human mind pushed to the very limits of endurance.

For Lavinia?

We aimed, in the second half of the week, to modernise and expand our notions of trauma, recognising PTSD as a condition that can be triggered by any distressing or life-threatening event. We looked together at an extract from Shakespeare’s early tragedy Titus Andronicus, which provided the literary inspiration for Peter Robinson’s poem ‘For Lavinia’.

This extract from Titus has long divided opinion among critics, and we expect that your responses to the scene will be similarly mixed in the comment sections this week. It is possible to interpret Marcus’ speech as a human and humane response to Lavinia’s suffering; uncontrollable talking is, after all, a natural reaction to shock. Some would argue, moreover, that the language of Marcus’ speech is immensely moving, conveying the character’s love for his niece, and his futile desperation to reverse her horrific mutilation. For many readers, audience members and critics, however, the monologue is deeply troubling. The stark contrast between Lavinia’s gruesome physical suffering and Marcus’ beautiful language can seem appallingly insensitive and inappropriate; indeed, it is not uncommon for the speech to be shortened, or even cut altogether in performance. We might take issue with the way in which Marcus’ speech seems to foreground his own emotional response, overlooking Lavinia’s experience even as it attempts to speak for her. As we heard from Peter Robinson later in the week, such concerns were present in the writing of his poem, cutting the text off at its conclusion; ‘Lavinia’, the poem ends, ‘I’ve said too much already’.

A third interpretation, which we touched on in one of the week’s videos, rationalises this horrific, theatrically problematic moment by suggesting that it isn’t supposed to be a realistic one. Particularly in his opening lines, Marcus employs the language of sleep and dreams, arguably establishing, within his monologue, an unreal quality from the outset. The detailed, oddly beautiful description might be suggestive of a slow-motion moment, in which Marcus registers – or, perhaps, fails to register – the extent of the horror before him. Later in the week, Kate Behrens talked about the way in which a terrible shock can interfere with perception, making everything appear unusually vivid, and seeming to slow down time; if we choose to interpret Marcus’ speech as a moment of slowed down and intensified perception, Kate’s insight seems a particularly illuminating one.

In our final videos of the week, we spoke to Kate Behrens and Peter Robinson about their own experiences of PTSD, and listened to some of their poems in which these experiences are addressed. We found their testimonies immensely moving, and we hope that these conversations will have been a source of comfort or reassurance for some of our learners, who may have been able to identify with some of the experiences of PTSD described. Kate and Peter could relate to many of one another’s symptoms, but their individual accounts also demonstrate how differently PTSD can manifest itself from person to person. The symptoms of PTSD are specific to the individual, and to their particular trauma. As we discovered in our conversation with Dr Jennifer Wild, moreover, an event that does not trigger PTSD in one person may still trigger it in another; there should be no shame associated with an individual’s reaction to a traumatic event, and no pressure put on a person to respond in a particular way.

Coming soon

Next week, we’ll be looking at two related conditions: depression and bipolar disorder. Again, we’ll be exploring literary accounts of these conditions that pre-date formal medical diagnoses, and we’ll be speaking to Dr Andrew Schuman to find out more about how depression and bipolar disorder are understood and treated today.

As well as considering these conditions from a medical perspective, we’ll be talking to Rachel Kelly, Melvyn Bragg and Stephen Fry about their own experiences of depression, and about how literature has been a source of solace and support for them during difficult times. We’ll also be thinking about how literature can help friends and family members to understand a loved one’s experience of depression or bipolar, and we’ll be talking to the writer Mark Haddon about his play Polar Bears.

We’ll once again be addressing some sensitive and potentially upsetting topics over the next week of the course. Some of you may already have chosen to skip certain steps, and we’d encourage all of you to continue to exercise your own judgement, leaving any material that you think may be distressing rather than helpful to you.

Final thought: ‘3pm. Cured.’

Our final thought, this week, takes as its starting point a phrase that struck us – and no doubt many of our learners – as both unsettling and ironic. A title-card in the video of ‘War Neuroses’ symptoms, filmed at Netley and Seale Hayne military hospitals, declared that one particular soldier was ‘cured’ after just one hour of treatment. His physical improvement was remarkable, and whether or not this piece of footage was a re-enactment, it is undoubtedly the case that doctors at military hospitals during the First World War performed incredible and unprecedented work to treat the more obvious symptoms of trauma in many soldiers. But the severe psychological distress that triggered these symptoms is unlikely to have been erased by 60 minutes of therapy. As we learned from Dr Andrew Schuman and Dr Jennifer Wild this week, PTSD is a very difficult condition to treat, with traumatic flashbacks sometimes plaguing a sufferer for many years after the original event.

While there may be no straightforward and guaranteed cure for PTSD, however, there are a number of different strategies which can help to manage the condition. We often assume that talking about a traumatic experience is essential to recovery, but some recent studies have demonstrated the importance of time, and the possible value of avoiding or ‘burying’ a trauma memory for a period after the event. At the appropriate time, of course, writing and talking therapies can be immensely helpful be in exorcising or, at least, modifying traumatic recollections, so that they no longer cause so much anxiety. Cognitive behavioural therapy, occupational therapy and pharmacological treatments are some of the other, most common methods for managing the condition and its symptoms. PTSD is a severe and debilitating mental health condition that cannot be cured in an hour, but there are, as we have learned together this week, a variety of treatment approaches available, that can and do help sufferers to manage and, even, to master their symptoms.